Healthcare Provider Details

I. General information

NPI: 1760397525
Provider Name (Legal Business Name): MARCELA MUJICA, DMD, A, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 THE PLZ STE 4
CHARLOTTE NC
28205-2407
US

IV. Provider business mailing address

2501 THE PLZ STE 4
CHARLOTTE NC
28205-2407
US

V. Phone/Fax

Practice location:
  • Phone: 980-425-3100
  • Fax:
Mailing address:
  • Phone: 980-425-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: HEATHER JERNIGAN
Title or Position: OFFICE MANAGER
Credential: JERNIGAN
Phone: 704-649-3580